Platinum Derivatives During Pregnancy in Cervical Cancer

Abstract

Cisplatin may play a significant role in the management of patients with cervical cancer during the second and third trimesters.

How much platinum passes the placental barrier? Analysis of platinum applications in 21 patients with cervical cancer during pregnancy

“…2,26 Up to the end of 2012, 24 small studies and case reports had been published on this issue, and only a few have been added in subsequent months. 27,28 According to international recommendations, the prognosis in women with early cervical cancer does not seem to be worsened by either pregnancy itself or by delay to await fetal viability.…”

“…Although there are accumulating data in the literature concerning the administration of cisplatinum and carboplatinum during pregnancy, the safety of these molecules for the fetus remains uncertain. 2,[15][16][17] On the one hand, pregnancy is associated with physiological changes in plasma volume, placental passage, and hepatic and renal metabolism. These particular alterations may significantly affect pharmacokinetics of chemotherapy drugs.…”

“…[2][3][4][5][6][7][8] Management of cervical cancer complicated by pregnancy depends on several factors, such as the stage of disease (tumor size), lymph node involvement, duration of pregnancy, histological subtype, the parent's wish to continue pregnancy, and future child-bearing desire. [9][10][11] There are only a few available guidelines and reviews for the treatment of pregnant women with cervical cancer.…”

Cancer Treatment in Pregnancy

“…Most of these regimens involve cisplatin, either alone or combined with other drugs, including bleomycin, 5-fl uorouracil, paclitaxel, vincristine, and bleomycin. A recent review and meta-analysis of case reports, while limited, shows complete or partial response in most patients without signifi cant adverse fetal outcomes [ 45 ]. Cesarean delivery seems to be preferred mode of delivery in these cases, with a vertical uterine incision away from the lower uterine segment.…”

Cervical cancer in pregnant women: treat, wait or interrupt? Assessment of current clinical guidelines, innovations and controversies

“…In this series, all patients that received paclitaxel with platinum combination therapy had partial remission in contrast to single-agent treatments [Fruscio et al 2012]. Based on its toxicity profile and also experience in ovarian cancer, paclitaxel with cisplatin or carboplatin is recommended during pregnancy [Amant et al 2009;Zagouri et al 2013]. The use of ifosfamide during pregnancy is not recommended due to its reported foetal toxicity, although Mir and colleagues have treated five patients with sarcoma during pregnancy using doxorubicin and ifosfamide without adverse events [Mir et al 2012].…”